Diagnosis and Treatment of Gallbladder Polyps: Current Perspectives

Abstract

Introduction: Gallbladder polyps (GBPs) are generally harmless, but the planning of diagnosis and treatment of the GBP is of clinical importance due to the high mortality risk of delays in the diagnosis of gallbladder carcinomas that show polypoid development.

Materials and methods: GBPs are usually incidentally detected during ultrasonographic (USG) examinations of the abdomen. The risk of carcinoma development from polypoid lesions in the literature is reported as 0-27%. There is no consensus about the management of the GBPs. Herein, we reviewed the contemporary data to update our knowledge about diagnosis and treatment of gallbladder polyps.

Results: Polyps can be identified in five different groups, primarily as neoplastic and non-neoplastic. Cholesterol polyps account for 60% of all cases. The most common (25%) benign polypoid lesions after cholesterol polyps are adenomyomas.

Conclusion: Ultrasonography and endoscopic ultrasonography seems to be the most important tool in differential diagnosis and treatment. Ultrasonography should be repeated in every 3-12 months in cases that are thought to be risky. Nowadays, the most common treatment approach is to perform cholecystectomy in patients with polyps larger than 10 mm in diameter. Radical cholecystectomy and/or segmental liver resections should be planned in cases of malignancy.

How to cite this article: Dilek ON, Karsu S, et al. Diagnosis and Treatment of Gallbladder Polyps: Current Perspectives. Euroasian J Hepatogastroenterol 2019;9(1):40-48.

Keywords: Diagnosis; Gallbladder polyps; Pathology; Treatment; Ultrasonography..

Fig. 1

Sagittal section of gallbladder specimen shows true neoplastic polyps on the neck (arrows)

Figs 2A and B

Adenomatous polyps of gallbladder (adenomatosis); (A) fresh and (B) fixed

Fig. 3

The opened gallbladder specimen shows round, yellow, pure cholesterol gallstones (arrows) and a geographic yellow mucosal surface caused by cholesterolosis (strawberry gallbladder)

Fig. 4

Gallbladder adenomyomatosis with focal wall thickening (arrow) involving the fundal region

Fig. 5

Transabdominal USG shows that a sesile gallbladder polyp were defined as immobile and lack an acoustic shadow

Fig. 6A and B

USG shows multiple polyps in the same position at different angles (A and B) without acoustic shadow

Flowchart 1

Proposed management algorithm for gallbladder polyps